Current Status on ICD 10 Implementation

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Current Status on ICD-10 Implementation
Presented By Victoria, thepracticebridge
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• We will be using ICD-10 another 19 days. Before
  that I will make you to walk through the status
  on ICD-10 implementation.

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I have few questions in my mind

• Does the claims errors will Increase?
• Will A/R could rise?
• Will there be a rise in claim denial rates?

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• 2015 survey was intended only for healthcare
  providers. 60 responded on behalf of a hospital
  or health system. Hope we will get more
  clarifications if we go through the survey.

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• According to the survey, just 7 of physicians
  said they have started transitioning to ICD-10
  extensively.
• 31 of respondents said they had not started the
  transition at all.
• Among solo physicians, 82 said they have not
  started the transition at all or have made only
  limited
• 42 of respondents said they are "not at all
  confident" that the implementation of ICD-10 will
  cause no serious disruptions.
• 83 of respondents expect the transition to
  result in delayed or denied claims
• 36 expect to face disruptions that require them
  to draw from personal funds

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• 32 said they might reduce staff size, work hours
  or benefits and
• 30 said they might retire early because of
  anticipated cash-flow issues related to the
  transition
• 65 said they are capable of processing ICD-10
  codes
• 52 said their practice management software was
  capable of processing ICD-10 codes
• 1 said they will need to completely replace
  their IT systems to comply with ICD-10.

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A recent survey of 1,100 organizations found

• More than half of respondents were uncertain of
  the actual ICD-10 deadline.
• And more than half had not yet completed
  end-to-end testing.
• Some providers still believe the switch to
  ICD-10 isn't going to happen this year.

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• "This is an off-election year, and if I was a
  politician, I would roll ICD-10 out during an
  off-election year rather than delay it," says Mr.
  Joshua Berman, Relay Health ICD-10 Director.

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• Provider organizations that haven't adequately
  prepared for the switch are going to have issues
  with the processes that ICD-10 requires. However
  even organizations that have prepared may still
  have problems.

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This isn't a technology change, it's a
process change

• The switch to ICD-10 requires coding staff,
  physicians and all others who document conditions
  to be properly trained to ensure billing is done
  correctly.

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• All providers are likely to encounter some issues
  with the switch to ICD-10, including an increase
  in claim denials and the amount of time it takes
  payers to process claims

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• For small practices Road to 10 from CMS has
  primer for clinical documentation, clinical
  scenarios, and other specialty-specific resources
  to help with implementation.

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• Medicare claims processing systems will not have
  the capability to accept ICD-9 codes for dates of
  services after September 30, 2015

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6 foundations for ICD-10 implementation you
cant ignore!

• ICD-10 CM/PCS Communication
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• Coding Education
•  
• Clinical Documentation Initiatives
• IT Plan
• Revenue Cycle Plan
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• Post "Go Live" Health Information Management
  coding activities

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Communication

• Concise Messaging
• Vision Statement
• Partners Roles
• Timelines
• Defined Methods of Communication

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ICD-10 CMS/PCS Vision Statement

• Clarity-steering the team in the right direction
• Inspiring and meaningful versus compliance driven
• Expected outcomes-how we will be working
  differently following ICD-10 implementation

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Partners and Roles

• Identify
• Internal groups
• External groups (Partners)
• Agreed upon communications

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• Have a timeline that outlines milestones,
  secondary tasks and deadlines keep implementation
  teams on task.
• Multiple communication methods should be used
  Thumb of rule says, seven times, seven ways

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Coding Education

• Self assessment goals checklists
• Rate your self on a scale 1(Goal not accomplished
  at all) to 5(Goal accomplished)
• Are you aware of your foundational knowledge
  strengths related to AP, disease processes,
  pharmacology, etc.?
• Are you completing tasks to improve your
  weaknesses related to AP, disease processes,
  pharmacology, etc.?

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• Are you networking with a subject matter expert
  and peers?
• Are you practicing and applying codes to real
  world documentation?
• Are you working to understand the ICD-10-CM/PCS
  coding guidelines?
• Are you gaining a deeper understanding of the
  clinical documentation improvement protocols?
• Do you work collaboratively with clinical
  documentation specialists when a clarification or
  query is needed?

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Clinical Documentation Improvement

• The success for this includes
• physician involvement
• communicating documentation gaps
• Other key data findings
• Which agree upon goals of a CDI improvement
  process and ongoing focused reviews with
  feedback.

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• Medical staff, CDI staff the coding staff will
  need education on the findings from documentation
  reviews
• Findings should include discussion of the
  documentation elements needed to support ICD-10
  codes through use of specific examples.
• The value of more concise data capture for high
  quality data should be emphasized.

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IT Block

• For the most part, IT plans for the transition to
  ICD-10 are well underway, due in part to the
  conversion to 5010 compliance.
• Important elements of the IT building block for
  ICD-10 readiness to be monitored throughout the
  implementation include.

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• Communications to and from vendors
• Testing of system capabilities
• The costs associated with IT implementations
• Necessary upgrades and system maintenance.
• Decisions around how ICD-9 and ICD-10 databases
  will be accessed and maintained will need to be
  made.

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Revenue Cycle Block

• The 9 pieces of advice from Government Health IT
  practices must consider
• Practices should develop a budget and strategy to
  provide for additional cash reserves should
  delays in payment occur.
• Practices should conduct financial modeling to
  understand the impacts of moving from ICD 9 to
  ICD 10 the impacts should be looked at by
  provider, by facility, by service line, and by
  geography if applicable.

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• The potential for backlogs in medical Coding,
  billing, and claim edits should be analyzed and a
  strategy developed to work the backlogs.
• A strategy for pre and post ICD 10 denials
  management should be developed.
• Assess the readiness of external vendors who
  support coding, billing, follow up and denials.
• Any audits currently performed (compliance, RAC,
  etc.) should be reviewed to determine ICD 10
  impact.

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• Managed care contracts should be reviewed and if
  necessary, renegotiated to decrease negative
  impacts to the bottom line.
• The readiness of high volume payers should be
  assessed to determine their ability to process
  claims. Many payers are now posting readiness
  information on their web sites.
• Conduct CDI reviews using ICD 10 code sets to
  determine if documentation contains the
  specificity necessary for ICD 10.

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Post Go Live HIM/Coding Activities.

• Most important block for ICD-10 implementation is
  to plan the activities to undertake following the
  deadline. As Sir Walter Scott said, I can give
  you a six-word formula for success Think things
  through then follow through

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• Practices must follow through and monitor coding
  accuracy and productivity following go live.
• When problems are identified, strategies should
  be implemented to address workflow problems,
  process problems, and resource issues.
• Determine if further education and training is
  needed and provide it expeditiously to prevent
  future issues.

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• Monitor for opportunities to improve data
  integrity through EHR enhancements, monitoring of
  alerts, and communication with physicians
  clinical documentation improvement staff.
• Finally, monitor productivity to manage
  responding to staffing needs.
• Go live will be a challenging time for all and
  retention of highly trained, skilled coding staff
  will be essential.

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• Which of these building blocks needs more
  attention in your organization? Which has been
  successful?

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